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Disorders of bleeding (Acquired (Drugs (Warfarin, Aspirin, Heparin),…

- - - - Role of liver in coagulation
        
        Synthesis
        
        Coagulation factors
        
        Protein C and S
        
        Thrombopoiten (TPO)
        
        Carboxylation of Vit K
        
        Clearance
        
        fibrinolytic factors
        
        activated coagulation factors
        
        Liver disease can cause bleeding and thrombosis
      - Management
        
        Avoid non-essential procedures
        
        Monitor coagulation
        
        Fresh Frozen plasma, cryoprecipitate and platelets if actively bleeding
        
        Response usually poor to Vit K
  - - - Presentation
        
        Patechiae
        
        Brusing
        
        Occasionally nose bleed or heavy peroids
      - Investigation
        
        FBC
        
        blood film
      - Aetiology
        
        Autoimmune
        -destruction of platelets
      - Management
        
        General measures
        
        monitoring
        
        trauma advice
        
        avoid platelet drugs e.g. aspirin
        
        1st line
        
        Prednisolone
        
        Immunoglobulin
        
        2nd line
        
        Rituximab
        
        High dose dexamethasone
      - Prognosis
        
        Most children recover
        
        Some develop chronic ITP
        
        Most require no treatment
  - - - Aetiology
        
        Coagulation pathway activated in an inappropriate and diffuse way
        
        Always secondary
        
        Affects 25-50% of septic patients
        
        Associate with high mortality
      - Presentation
        
        features of underlying disease
        
        bleeding
        
        Microvascular thrombosis
        
        Organ failure
      - Investigation
        
        PTT (raised)
        
        APTT (raised)
        
        Platelets low
        
        D-dimer +ve
      - Treatment
        
        Treat underlying condition!!!
        
        Platelet transfusion
        
        Fresh Frozen plasma and cryoprecipitate
        
        Recombinant activated Protein C in severe cases
      - Prognosis
        
        Depends on underlying condition
        
        Associated with end organ failure and poor outcome
        
        Appropriate care can lead to a favourable outcome